ERA/EMMA/ALICE Testing Thread 3

[Janefx40]

Hello all,

This is a continuation of the ERA/EMMA/ALICE Testing thread.

New posters are welcome. On here you will find a group of women who are either doing these tests or have done them already and are further on the journey

This is the friendliest and most supportive group so feel free to join and post

Xxx

Hi, I hope you don't mind me joining. I've had a little scan through and this thread looks full of good info!
I've been recommended the ALICE/EMMA/ERA tests from care. Our first cycle was terrible with only 2 eggs, 1 above average embryo, didn't take. Second cycle got 17 eggs, 6 very good embryos, one didn't take and the other 5 were PGT-A tested and only 2 euploids. Was due to do the tests this month but panicked and we decided to push another EC through to try and get some more euploid embryos. I'm 40 this year so time is of the essence, although my AMH is 20 so quite decent, just quality must be poor now.
I'm interested to hear if anyone has had anything show up on the tests and what can be done about it? Are the tests worth doing?
I also think my progesterone levels were too low as AF came a week after ET whilst I was still on the progesterone tablets...do you know if this is something I should push with them? Any advice welcomed 😊

Learning how to use @ now! Lol.

@Gardenlady543 It must be really handy being a doctor in all of this! In terms of my eggs, I get 5-7 mature eggs per round, 4 always fertilise (every cycle), 3 of 4 make it to blast with 2 being average of good quality (the other tends to be poor eg CC). All have been on short protocol with menopur of varying doses. But there’s no change in the number of eggs or blasts according to dosage - it’s like my body can only muster up 4 good eggs per cycle. PGS testing is definitely a priority moving forward - but then I hear there’s problems with that too!

@StillTrying10000 Sorry to hear about your loss ❤️ I’ve been on the pred thread previously when I first got my nk cells diagnosis, so will revisit it to read up on Shehata. I considered consulting Shehata after my odd uterine nk cell results as he does quite thorough immune testing - but as I live so far away, I’d struggle to get there for treatment. So I’m unsure if there’s much point. I wish this wasn’t such a minefield.

@Coops0406 definitely push the progesterone issue. They should take a progesterone blood test just before/after your ERA/EMMA/ALICE. If this is low push for progesterone in oil injections. They don’t like to prescribe them as they’re painful - but so are repeated failed transfers 🙄

I had a bleed similar to you on my first transfer. I asked for a progesterone blood test before my second transfer of a great embryo and I was pooh poohed and told people don’t need more progesterone than I was on.

I moved clinic then and insisted on progesterone bloods. At my ERA after 6 days of x2 Progesterone pessaries my progesterone was 4! It should be >50. My consultant said he had never seen such a low level.

@Dochas1211 thanks for that. Have you had the injections? Awful that they wouldn't do a blood test just to check to at least put your mind at ease! Have you had the other tests too? Do they do them all at the same time? I'm hoping after EC this month they could jump onto it for my cycle in feb 🤞🏾

Hi. Could I join please? I am a bit of a failure all round with three euloid transfers going wrong, one early loss, one chemical and one late loss 16 weeks.
Going to recurrent miscarriage clinic soon.
done way too much googling

@BerryBright From my experience NK Cells have been important. Prior to going private I had been having recurrent miscarriages. I had NK blood test on NHS who prescribed hydroxychloroquine sulphate and I was successfully pregnant the following month and it stuck for the first time. Sadly that was the one I lost due to an infection loosing my waters at 16 weeks and I haven't been able to properly conceive since then. But it was amazing how easy and successful my first NK treatment was so worth considering. I had been trying to put off any internal tests but I've run out of choices now x

[quote Coops0406]@Dochas1211 thanks for that. Have you had the injections? Awful that they wouldn't do a blood test just to check to at least put your mind at ease! Have you had the other tests too? Do they do them all at the same time? I'm hoping after EC this month they could jump onto it for my cycle in feb 🤞🏾 [/quote]
The ERA found my receptive window so to replicate that I couldn’t change the progesterone dose so I had to take just the 2 pessaries per day but an hour after the transfer I was given my first PIO. I got my progesterone checked two days later and it had gone from 4 to 91 and then two days after that to 125 so it does shoot up with the PIO.

Yes I had all 3 done at the same time. Found 0% good bacteria and high levels of bad bacteria. Antibiotics and probiotics brought my good bacteria up to 75% and bad down to around 12% - I had to do a repeat as the results were so bad.

Welcome everyone

@AdrianeMole I'm sorry for your losses 💐 yes come and join the chat. I'm not the most knowledgable on the tests but there are others on here with lots of knowledge.

@Coops0406 welcome also. It sounds sensible to bank more embryos. I did the tests because I'm 44 and we've two euploids and aren't doing any more collections so as my consultant said "our embryos are precious". I had good but not perfect microflora so was given probiotics to improve this. My NK bloods are high but biopsy was normal so will be doing intralipids. Others have had different results and had treatment. I probably didn't need to do the ERA as I've had previous embryos implant but thought we might as well do it just in case. Came back normal.

I definitely think progesterone is something you should push. It's important and so easily managed - there's no reason not to test and ensure levels are decent. Our clinic will do extra tests if asked (you'd have to pay extra but that's fine) so hopefully yours will do it if asked too.

xxx

Thank you @Janefx40, I think you replied to another post of mine elsewhere and suggested this thread.
I haven't had the microflora test but I am assuming I will soon as I do wonder if that's my problem.

Welcome everyone.

@Coops0406 after my first transfer my period arrived after 5 or 6 days. I rang my clinic and went for a blood test that day and for all subsequent tries have been on lentogest (progesterone in oil injections) since. They said there's no point in re-checking my levels as it's synthetic so won't show up. Sounds odd but i think it works as I haven't bled early since.

For anyone new the ERA/Alice/Emma for me showed I needed to start progesterone sooner and that I had low (but not really low) levels of good bacteria so did a course of vaginal and oral probiotics. If you don't end up doing the tests you should definitely take a good women's probiotics.

For me my breakthrough (I hope it's my breakthrough!) was a saline sonogram (recommended by two wonderful ladies on here) that showed I had a big adhesion in my uterus acting like a natural coil. It had previously been misdiagnosed 2 1/2 years before during a hysteroscopy as a midline septum (a ridge that shouldn't matter much) and then surgery to remove it. I've had 5 transfers with no BFP and two unsuccessful pregnancies in the past 4 years. I do have a naturally conceived 5 1/2 year old.

Oh wow @Coops0406 that's a big difference in the amount of eggs between the two cycles and a lot of eggs were collected in cycle 2 for your age. The rate of euploid embryos out of the ones tested is very good! If you can get another 2 euploid embryos in a cycle I think that would be a great achievement!

I would say that you should make sure you have some imaging (hsg or saline scan) and an ERA EMMA ALICE before a transfer as the embryos are difficult to get, you will need to make sure everything is perfect before another transfer.

@BerryBright I think 4 embryos per cycle is likely average and the drop seems ok, I think about 50% can drop off at the maturity/fertilization stage and 50% won't become blasts. Endometriosis can affect egg quality, not sure there is an issue with it from your numbers, but if you have symptoms suggestive of the condition then it's definitely worth exploring.

Hi @AdrianeMole welcome! Ah bless you, I'm having issues with my euploids too, in my case they don't implant. I think the miscarriage clinic will be a good idea, have you had any tests yet?

@seven201 that sounds really odd about not testing your levels on lentogest. I've never had lentogest but have had prontogest, Lubion and cyclogest in different cycles and all three of those show up in bloods. Still as long as it works for you then that's the main thing!

Marking my place

[quote Janefx40]@seven201 that sounds really odd about not testing your levels on lentogest. I've never had lentogest but have had prontogest, Lubion and cyclogest in different cycles and all three of those show up in bloods. Still as long as it works for you then that's the main thing![/quote]
It is really odd. I've asked a few different people at the clinic and they've all said the same. As you say though, as it seems to work I'm not going to push it.

Hi @Gardenlady543,
I had basic anti clotting bloods done after my second loss. I didn't have APS or thyroid issues. I think the recurrent clinic will do more in depth tests. I am very interested in the microflora question though as that's where a lot of my googling has got me especially after my late loss.

@AdrianeMole - which recurrent clinic are you at? Sorry to hear about your issues with the euploid transfers.

@Gardenlady543 - I feel my cycles seem pretty standard (i.e., not particularly good, but not bad either) - I've always made blasts, just none have implanted. My concerns with endo/adeno seem to have stemmed from conversations with people on other forums, where I've realised my blood loss & pain seem extreme (though totally normal for me!).

@BerryBright it sounds like it's worth exploring then, you'll need to get referred for a lap.

@AdrianeMole I think they'll probably do quite a few blood tests. The microbiome you can explore in one of two ways with the EMMA ALICE, you'll need to arrange it at your fertility clinic, they'll put you through a mock cycle and take a endometrial biopsy which goes off for testing. I just did my third analysis through fetilysis, you collect a sample of menstrual blood and do a vaginal swab mid cycle and send them off. The latter works out cheaper so you might want to explore that while having the tests through the miscarriage clinic.

Thanks @Gardenlady543. Everything I'm reading is talking about lactobacillus crispatus as the best bacteria for reproduction, I see there is a trial going on for it. I really want to get my hands on some lactobacillus crispatus probiotic but it doesn't seem to exist.

Lols - I have just realised how nuts my message reads. I have gone bananas with the google research! I probably need someone to take away my laptop!

@AdrianeMole I think you can only get lactobacillus crispatus in oral form rather than vaginal tablets which would be better. If you're going to do the testing then I would keep living as you were because if this has been an issue then it will be helpful to know. Oral probiotics should be ok but don't do vaginal before the investigation as it will affect the result.

Sorry I can't remember who recommended this one in the thread, but it has it in @AdrianeMole

https://naturaldispensary.co.uk/products/BioMeeFemmeVV60_s-10002010-1271.html

Thanks @Gardenlady543!
Did someone have success with this after testing?
It's so hard to know which products actually might work. I totally get what you mean re not changing things before testing so I will think about that.

@AdrianeMole I took a huge amount of oral probiotics with evidence of improving the gynae microbiome between my first and second EMMA ALICE, it made no difference I still got a result of 0.00% lactobacillus as I needed a further course of antibiotics. So I guess it depends if you have lactobacillus just below 90% and you don't have huge amounts of dysbiotic bacteria then it will probably help. Otherwise you really need a treatment plan from an analysis (either fertilysis or EMMA ALICE).

Ah @Gardenlady543 so sorry that is so frustrating.
I am going to see if I can get an analysis soon. Not sure if I will wait for the recurrent miscarriage appointment which I don't have yet.

@Gardenlady543 You are so knowledgeable on this. Do you know whether the uterine biopsy (ALICE/EMMA) test is better than the menstrual blood test? Or are both equals? I'm thinking it might be a useful test to run while I'm looking for a new clinic.